Multiple sclerosis is a neurological disease of the central nervous system in which the immune system (patient’s own immune system) attacks myelin, which is the substance that acts as an insulator of neurons and is necessary for the effective transmission of nerve impulses. As a result of this inflammatory attack there is demyelination of the central nervous system that can eventually lead to the appearance of neuronal degeneration and permanent neurological sequelae.

It is a relatively frequent disease (about 1 in 1000 people, according to the most recent estimates) that affects young adults (the average age at diagnosis is around 30 years), predominantly women,  although it can also be diagnosed in children and in elderly people. Multiple sclerosis is considered the first cause of neurological disability in young adults, even above, in some estimates, of traffic accidents.

Multiple sclerosis can present with multiple symptoms, although most often it manifests as sensory deficits (sensory deficits, tingling …), motor (weakness in legs or arms, incoordination, gait imbalance, intense fatigue …) or visual ( loss of vision of one eye, double vision …), especially in the early stages of the disease. However, over time, other symptoms of cognitive type (memory, orientation, ability to stay focused …), affective (depression, anxiety, insomnia …), sphincters (urinary urgency, constipation …) or sexual symptoms may appear (impotence, loss of libido …). For this reason it is called the “disease of a thousand faces” since virtually every patient has a specific profile of symptoms.

The disease, in its most frequent form, called “relapsing-remitting” manifests with relapses. A relapse is a neurological episode of new onset, lasting more than 24 hours, which is established in hours or days, that gets worse to a nadir in which it stays for several days to then recover, either spontaneously or after treatment with corticosteroids. This recovery may be complete or partial. In the so-called progressive forms, relapses and constant worsening of symptoms can occur without subsequent remission. Patients who present with continuous progression of the disability at onset are classified as affected by primary progressive forms and patients with secondary progressive multiple sclerosis are those who begin a progressive phase after having had a recurrent-remitting phase of the disease.   

Although this is the classic definition of the different forms of disease progression, currently multiple sclerosis is classified as being active or not (depending on whether there is an relapse or new lesions) and progressive or not (depending on whether there is or no progression of disability regardless of the presence of relapses).

Multiple sclerosis is diagnosed based on diagnostic criteria that include symptoms and neurological examination, cranial and spinal magnetic resonance imaging, lumbar puncture and the exclusion of other similar diseases.

Multiple sclerosis is a treatable disease. Multiple treatments are available for care. Among the treatments we have those that properly treat the mechanisms of the disease and try to stop its effects (disease modifying treatments), symptomatic treatments (address the symptoms of the disease but do not modify its course) and rehabilitation therapy. The disease modifying treatments, in turn, are classified according to their effectiveness and side effects profile in first and second line treatments.

• Modifying treatments in Multiple Sclerosis
  • First line
    • Interferon beta (Beta1b: Betaferon and Extavia, both subcutaneous. Beta1a: Avonex (intramuscular) and Rebif (subcutaneous))
    • Glatiramer Acetate (Copaxone and Mylan Glatiramer Acetate, subcutaneous)
    • Teriflunomide (Aubagio), oral, once a day
    • Dimethyl Fumarate (Tecfidera), oral, twice daily
  • Second line
    • Fingolimod (Ginlenya), oral, once a day
    • Cladribine (Mavenclad), oral for 5 days, rest one month, another 5 days, rest one year and repeat course in year 2 .
    • Ocrelizumab (Ocrevus), intravenous every 6 months
    • Natalizumab (Tysabri), intravenous, every 4 weeks
    • Alemtuzumab (Lemtrada), intravenous, 5 consecutive days, one year rest, 3 more consecutive days and rest according to disease progression.
  • Third Line (treatments used in compassionate use or when other therapies have been ruled out)
    • Mitoxantrone
    • Cyclophosphamide
    • Autologous hematopoietic progenitor transplantation (“Bone Marrow Transplant”).

In addition, clinical trials are frequently performed in multiple sclerosis, aimed at investigating the usefulness and safety of new drugs that may be approved as useful in the disease in the future.

Although it is a disease with a significant social stigma, usually associated with the use of a wheelchair and permanent disability, as in all diseases, there is a diverse spectrum of severity of symptoms and, therefore,  a diagnosis of multiple sclerosis can be held both by patients who follow an absolutely normal life and patients who are very disabled and with significant loss of autonomy. Particularly, the patients of long evolution and advanced age, those diagnosed when there were no effective therapies or those patients with progressive and aggressive variants of the disease, are usually those ones that are recognized as affected, although there is a significant number of patients who, despite the symptoms and the need for chronic treatment, they are able to develop a relatively active life, both in the workplace and in the personal sphere.